beatsQRS) rndependent, are stablp_P-l wrdth QRS depends of on lntervals, locat';;n escape usuaf Plrl, rate40 - 60/min. of t.

8EE0 - Rfi'/R-S.R' Vl or VZ > 0.12 sec with oossibte in ST (incomplete degression llipped waves; and T RBBB < 0.12 sec),wde R{' possible ware changes. 5 - l, aVL,V5,V6;maybe benign, T 6. LEEA R-R'hoQ or $ in l, aVLandV6;QRS >.12 sec, wde S Ul -:l?, no R-S{' in Vt, possrble wave T ch-anges,LAD, r difficulty inlarct ventricular dragnosing hypertrorhy Dresent. when or 1. Antertqr.Hgm!.f'lqq! "-_ ' zllQ rnI anday _ frl O
? -).i '-

rtffl.rr

O tglra lc,dr,d}lonulixt

S'lm,

,nc., 25llorscsoc [n., Stmfcd,

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USX

nernrciock RAD; 0.10- 0.12sec;S ln l; Q rnil, iiianoa,1: . ,steior QRS cl-.-;is (direction depofanzationl of Normal: -30"-++100" Left Axf Dcvleon[ADl: -30+ .90 ,a ' ,n. Right Arlr Dcyltlon IRAD): -150',aVR fv L ' J !' + 1 0 0- r + 1 8 0 ,- 9 0 ' - - 1 8 0 " T
+ 1 8 0 ' ,- 1 8 0 "

$e-_

l, oo

l. 2.

Evafuate aVF I and Findisoelec-tric andQRS lead axisis at 90"

aW 90'

(reciprocaf deDression changesl [X)r STelevation myocardial iniury,pericarditis; ventricular arrcurysrn, (Cor.aderyspasml, Prinzmetal's Angina LBBB, hypoernia. euly repofanzatin, Ml, DDr STdeoressnn Dig.,Subendocaral angna,LWl,RWf,ischemia, TC's,Strain,hypokalerrua, hypomagnesemia, }{FlY, criticafanena, 888's. Speclal Condltlon

largest inV5sr V6 35 mm;tahst Rh Vl - V6> 27 mm u V2pfus R possible deprssion Jlipped wawsnl, [, U aVL, aVF, V6; ;sible flipped and T S-T or V5, LVstrain;LAfl; in aVL 12mm. ? R lchcml,. l4lur}, lqfgqt lschemiaaisociated llatoriwevted is with Twaves. symmetricd fnfarct irurv and arerepresentedSTsegment by elevation dpression leadsl. warel or freciprocal 0 (acute ofdl, (< indicate infarcbn ahd althugh Qwavcs 0.04scl berixrnaty rnay tiny inl, ll, al/L, and LBBB V5 V6. corrrplicates cfiagrcsis acute seen tlrc lll of l.,pceon Lead Anterior v 2- v 4 LeftAnt.ffi*(teDl fuiteroseptal VI .V4 rD Anterolateral Vl - V6, l, aVL LAD,0iagonal Inferior ll, lll, aVF RCA, Circumilex l,_aV!,V5 - V6 Lateral _ CrcumfQl Diagonal Posterior largeR Wave V2, or V3 withST Vl, RCA

part in Vl in llf endaVF); largedrphasic wavewithtallinial P and phase; 2. Lefttfll- diphsic in Vl withlargeterminal P downward (P mitrale wide),M shped in l, ll or aI4-. P > 0.12 sec. P /l'l*RitVentriculE l.troefhonhv 3. Wtl*8if,VentrculEl.tmeftronW RAD> 100"; incomplete RBBB Vl; in Vl; R rnm R > S iqVl;R > 5 mm in Vl; decreasng wave -r V4; STdepressron decreasrng R Vl depressiq and patternl?Bll; low vofiOge tlppgd Vl - V3 IRVstrain rnl I x lt; rowYo[8ge t's Flvoertrootu t-AD withoutLBBB l,FE;deepest in LBBI or l,.A}ts-; or de_epest i S - 140 wttho{rt t kltt Yentricular :-

lfypcrtrophy (may l. BihtritallP ,. 1,5Fq inheight.in pulmonalel, be also lf lP BiqhtAtrilEqpl$p{.;- tall > 2.5 mm heightin lf.{P

I 'T
g-

fir-

ttr

I :.

E -* I r_

Normrl P l l y! < 0.10sec,l -1, ff;l -al R n PRffierval: 0.12 - 0.20 sec,decreases ST rone 0.10 sec;T - l, fl,V5,V6; l - avR,Vl; transition - v3; t or I - a!t, Vf , min05tL le chestleadsheisht< 27 mm R oI Anqrnft0: 0.01 sec., > 25f/o heightof fo$oning tffilTl I ischemia, Abnormalf s:1vH-V6, Mt, V6; I- avR; LBBB, subendocarat may be hverted- fl, a!F, al'L, Vl 0T htarval(dcpolariratron repolariationl: - 0.42 secor 4096 RRnlerval; THR and 0.34 ol -+ shoer0Itoiterval ll0c,/nin -0.31 t .O1sgr.,9o/mh-0.32 t .Ol sec,ffi/mn -0.33 t .04 sac. 70/ffn -0.36 t .05 scc, 60lntn - 0.38 t .05 secl

oor{t!ffi9:tgglfi

papcr 25rnn/secl; box 0.04 r I mm; larse speed Smar o sec dark

.trfl"T/?and
2. 3.
>l

Rtr ( / RRhtervals,?regularl: Tachytra > 100/nn, Eradycua< 60/mn Larrc 8or or 5 mm htervds: I + 3Oo/rdn 1250,211, 187. 167 - lmm nlervals 125,I 15,1071, -+ ltlmln (94,88,E3,791,-+ 73/rtn, 3 4 aftawadsl,2 -+ f JOlmh 1136, JO/nn,7 I a3/r, E 3E/nn,9 --r 33/nfi, l0 -+ N/mln. 5 + 6olr, 6 &a_ycardbs'(ilolDeatsper6sec/strbl0)wherc6sec/stnp.2marked3scccyrle nfiere 3 sac cycles= 15 darkfargeboxes Pacemaker!:SAnodc: 60 - 100/rit, Atrial- 75/mn, AVnode:40 - 60/min,Ventrkufa: n-1o/mh.

t60-I

cornpier complexes;

respiration, Dilholodcel, vuieble Pf menlal, non rcsp. SAis patholohd. not 4. llAT lftilollEid-triDyqrd,fiQ - 3 or rnorc differcn P wrys. normd QRS

. da-miifinJt*ry,Sb:*"-

t Witle

induccdbund brf1qh bfock,or with ronicr precrictatbn *fth tchyclrli; t P wans . my bc lxddenn QRScqnder,.

;f,i-9?,#1.'d1s/ffi:'#P;'&i? ro sa'; (> compfcx 0. l0 secl rnry erist withprecxistingburfdebrrnchbfock,taclrcadic QRS

' i't$l:

dcrta c. -i; lccaate--ncliniTC: aYF lmry be antegra&, retrtryvtdc,c

t"f
cffi ' -'

T rutomrttcrty ol AVjrrrctbn: wcrtGdP wavcsh f n, hrictll; RzO crlUcCilness,tl[. or ncoptrylnctorrcity, norScE thoacr ${&ery, mlocafoos, H, lrypokderna. $r8ery,rnyocarditi!,^H,lrypoidefna. 7. PAC.?rirnaiuraAtdd Coectin latriafoctoprcbeatl- WWaTs errly, t abnormdP wavc,lenen[y nomal QflS, nd from S node. Com*um (Av ilode ectoprcbctl - gcncr#y normalQRS, a. lv nmtiw absc fFl$Hc mt.tiw or absentP ware. no 3.Mi tvcntrkufr cctopicbertl - clr! wideQRS,

L'

Ts, widening 3. ttvnqdfplqmip peaked kie -r ffatP,wirre QRS, QT intenral, vyve, asystole sine arrhythmias, >T 4. ST U tA- flatT wa43, warbs,-U waes, depressirn 5. iE- shortQT 6. (trecordiat r tow : E *J?tH3.aJt ebvarion 7, flat or coneave teadsl,
ftot I tYgvrg

vanauct of I warc.q0anEs, stus.ru

fE tr il.Sitalr,ffifid8ilr'tRBBB

13: ffi;

imffii'ffc tff"stsecnbrdstrrnd*r
-

hr is
l

? tc

ir 3PuCs row, brord rltt&I alrteof t 00-2n/ I 6. roQiS n*u c orfrsftn bfts,AV LAO, dssocilbn, ftV ris, orcordnl wwl or R-$fi'; R>R'. corrnce; cmcorrnce; 0.1t 0.1_6 Yl *th R.S QRS - 0.16sGc; Hl wavta R-Sfi'; l/Fb no bascfite, tlistcrnbh 17.Ihlhrtl Fibriletin^ - crtrcdy irre8. bcats, . g BP
wd| Jr,il, rcpcrfusiq arrlttmia (spontancous with tlronbotyticsl, wmn $ pGrird,fu$on s beds.

retc b.sq!E, vrriabE ventric_ular lbrtdy -+ trcltltardil Vantriculcr situs pansel Atrid,Av_nodd, lS.Mf|oforYs

Td.-iiffi

(2:l irtc ratc-+ 150/nh block atrial 300/rnnl with 150/ih(2:

ouratr f atE rrv't

: ffi t-tiffi tl-dd'6ti ii'i'cs, irresutr mndy

8.

nh.L AV Rlnlrc vhb TC'e hmli 'itv Bbcks, variable Junctionat s, TC's, TC' 9 . oilir:irniii : b''k,- Trigeminy, VFb. W, PVC's, Bigeminy, ptobtged prolons P, PRS, depresson, Outqldttf P,-wde ST PRS, depresson, rxltced 1 0 . Q1fffyjde notcedwde ST --wid low flat BC, roftaga, deprassion, ll. or ST

T t inverted wanes. quJe of ST segment wrth? llat / t - dow.nward waves;shorterQT. qA

lr. Ei

*$*r*gt*8]i8:rfi ii'fl H,ITfi ,5,3; II: l8:fiiffijfft#ffi #fr*$*1*381i8:rfiH,[Tfiii' 's#fr

t:

t2. Flynert[oidism TC. - sinus

Stlot hdtdf edrnt cltfcl cotnbotr.

ffi:*t

qoclr | / Pfl-ienrd, ?QRSwih eachP, / n andRn htcruds, ?wktc QRS, RftA-S.f ir Vl, V2 s V6; aisl htcnC > 0.20soc, tt Ps ssociatedwirQRS - PR - ircreashg PR htcnd uir QRS

ircrcrshgPR ilcnd PR witout opped - QRS

Third0ctraq AVFtock-Comdeh AVhck - atrid lPsl andventrhdlr